‘Happy’ hypoxia: Covid-19 patients who should be gasping for air but aren’t

Some have called them "happy hypoxics", a terrible mistake for what could be a long, slow recovery – or worse.

The proper medical term is "quiet hypoxia." It happens when people are unaware that they are being deprived of oxygen and therefore appear in the hospital at much worse health than they realize.

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Typically, these patients have experienced some Covid-19 symptoms for two to seven days before they show up in the hospital and complain of sudden chest tightness or an inability to breathe deeply, says Dr. Richard Levitan, who has been an emergency room physician for around 30 years. year.

While practicing at Littleton Regional Healthcare in New Hampshire, Levitan recently spent nearly two weeks volunteering at the emergency room at a New York hospital near the city's devastating outbreak.

There he saw patients entering the emergency room with oxygen levels in their blood as low as 50%, so low that they should have been incoherent, even unconscious. Normal oxygen saturation in the blood is between 95% and 100%, and anything below 90% is considered abnormal.

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In addition, Levitan said, scans of these patients' lungs showed signs of pneumonia so severe that they would have terrible pain when gasping for the next breath.

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"Your x-rays looked awful, their oxygen was awful, and yet they are fully awake, awake on a cell phone, and they all said they have been a little sick for days, "he said.

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"And then only recently did they notice shortness of breath or fatigue or anything else," Levitan added. "That's what is so fascinating about this disease and also so awful."

This is terrible because when a person realizes that they have trouble breathing deeply and reaches out for help, they are already dangerously ill.

"Some may eventually require a fan." Levitan said: "As carbon dioxide levels rise, fluid builds up in the air sacs and lungs become rigid, leading to acute respiratory failure."

How can this happen?

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Doctors speculate that for some people, Covid-19 lung problems will develop in a way that is not immediately obvious. When patients focus on fighting symptoms such as fever and diarrhea, the body begins to fight back against a lack of oxygen by increasing its breath to compensate.

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"Imagine you had a full glass of air, and now the cup is half full," said pulmonologist for critical care Dr. Cedric Rutland, a spokesman for the American Lung Association.

"What are you going to do naturally? You're going to try to fill it twice as fast because you lost half," said Rutland, who is also assistant clinical professor at the University of California, Riverside.

People may not be aware of their faster breathing rate and are not seeking help, but their blood oxygen levels continue to fall. Meanwhile, the body is slowly adjusting to the lower oxygen levels, much like what happens when a person travels to a higher altitude.

As these patients come to the hospital with crippled lungs and crashed oxygen levels, "this has been happening for some time." Sa Rutland. "So your body is a little used to it."

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Nevertheless, the damage has already taken place. Not only are the lungs ravaged hard, the lack of oxygen may have already included other organs in the body, such as the heart, kidneys and brain.

A quiet hypoxia that rapidly develops into respiratory failure may explain why some younger Covid-19 patients without underlying health conditions has died suddenly after not experiencing any serious breathing difficulties.

Trying to avoid respirators

Early in the crisis, doctors put almost everyone who had breathing difficulties on respirators. Now they make reservations for those who are seriously ill, and realize that other measures, such as supplementation of oxygen and body, may work just as well for some patients.

In 2012, Levitan co-author of a paper where doctors offered 50 patients extra oxygen instead of ventilators and placed them on the sides and abdomen, positions are often used to help open the lower lungs.

"We found that two out of three patients can avoid a ventilator during the first 24 hours by putting them on oxygen and performing these position maneuvers, such as putting them exposed to the stomach," he said.

Keeping patients out of the respirators is a great benefit for doctors and patients. Ventilators are scarce and must be reserved for the sickest of patients. But even though each hospital had surplus ventilators, there are many reasons to try other methods first.

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In addition to a tube that is inserted down the nose into the stomach or surgically implanted into the trachea through the throat, patients can receive implanted tubes for feeding and to use the toilet.

Breather is not nice. Many patients need more sedative, so they do not withdraw. Bacteria can easily grow and cause "ventilator-associated pneumonia." There is an increased risk of blood clots.

Finally, people on respirators must be "awaited", a painful and scary experience that some people struggle with. Once they manage to reduce their addiction, about one-third of patients on respirators Get out of the experience with anxiety, depression or delirium, often referred to as "ventilator brain."

Early detection is key

Levitan recently wrote one opinion piece for the New York Times asking for a previous diagnosis of respiratory problems at Covid-19 by getting people with mild symptoms to use pulse oximeters during their two-week quarantine to monitor their blood oxygen levels.
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"Widespread screening of pulse oximetry for Covid pneumonia – whether people check in at home or go to clinics or medical offices – can provide an early warning system for the kind of breathing problems associated with Covid pneumonia," he wrote.

However, questions remain about the benefits of home use Pulse Oximeter to measure the oxygen level in the blood. First, it is possible that a number of the devices on the market are inaccurate. ONE 2016 study found only two of six popular oximeters to meet the accuracy criteria set International Organization for Standardization, an independent, non-governmental international organization dedicated to setting global standards.

In addition, abuse can affect readings. The device must be used properly; hands should be at room temperature; and dark nail polish can affect the readings, and it can also hold your breath.

Rutland urges patients he sees via telemedicine to use an oximeter to monitor oxygen levels. He feels that the devices, although not perfect, give doctors a way to triage ordinary patients they cannot see personally during isolation.

"As long as someone has a home oximeter and you know the person well enough, you can help them monitor this at home to get a jump start on whether or not they need to go to the hospital," he said.

"I think pulse oximetry is incredibly valuable if we were to use it in the time window that the disease begins to accumulate, which is usually five to ten days from when someone is first infected," Levitan said.

"Then the other thing is to measure inflammation markers when we observe them in the hospital and use the various medicines we have available to address inflammation. It's time to get ahead of this virus instead of chasing it."

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